College of Public Health

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Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit
(1997-06-01) Brittain, Paul D.; Licciardone, John C.
Brittain, Paul D., Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit Master of Public Health (Biomedical Sciences), June, 1997, 75 pp., 12 tables, bibliography, 16 titles. The primary purpose of this study was to determine the efficacy of osteopathic manipulative treatment (OMT) in improving clinical outcomes in patients who had undergone a surgical procedure for either a hip fracture or osteoarthritis affecting the hip or knee. OMT treatment subjects were recruited from an inpatient rehabilitation unit housed with an osteopathic hospital. OMT subjects received a standard course of OMT throughout their stay in the rehabilitation unit. Clinical outcomes were assessed principally through the administration of the Functional Independence Measure (FIM), a standard disability measure, to study subjects on admission to and discharge from the rehabilitation unit. Mean FIM score charges were compared between the OMT and a control group of similar patients. Receipt of OMT was associated with shorter length-of-stay, higher total FIM score change, and greater improvement on FIM locomotion items. These findings suggest that OMT is a beneficial therapy for this population of patients.
The Effect of Self Administered Workers' Compensation on Employee Safety Programs
(1997-12-01) Smitha, Matt W.
Smitha, Matt W., The Effect of Self Administered Workers’ Compensation on Employee Safety Programs. Master of Public Health, December 1997, 72 pp., three tables, seven figures, reference list, 28 titles. In Texas nonsubscribers to workers’ compensation have been under ongoing attack as powerful interest groups such as casualty insurance carriers have lobbied for an end to the elective system. Seventy-two nonsubscribing Texas companies were surveyed. Logistic regression with an alpha level of p=0.05 found the safety program qualitative score, Wald (1)=10.1992, p=0.0014 to be a significant predictor of increased management attention to safety while the other variables of total losses, frequency rate, and severity rate together in the same model were found to not be significant predictors of the same dependent response. Eighty-one percent of organizations surveyed reported that management attention to safety had increased after the company became a nonsubscriber.
Epidemiology and Diagnostic Testing of Tuberculosis (Mycobacterium bovis) Infection in Ungulates in a Texas Zoo
(1998-06-01) Hodges, Connie M.; Bidaut-Russell, Michelle; Licciardone, John C.; Murnane, Thomas
Tuberculosis infection among ungulates with Mycobacterium bovis (M. bovis) in a Texas zoo resulted in epidemiological assessment and testing of 161ungulates because of concerns about the validity of tuberculosis infection in the zoo. Three intradermal tests and one serological test were used to assess M.bovis infection : 1)the comparative cervical tuberculin test (CCT) consisting of biologically balanced bovine purified protein derivative (PPD) and avian PPD; 2) the single cervical bovine PPD tuberculin (BPDD); 3) the Tuberculin-Mammalian (MOT) intradermal tuberculin; and 4) the serological blood tuberculosis test (BTB). All four tests were evaluated. Validity (i.e. sensitivity and specificity), positive predictive value (PPV), and negative predictive value (NPV) were measured. The MOT followed by the BPPD were the most sensitive tests, correctly identifying 100% and 67%, respectively of tuberculosis infected/exposed ungulates. The BTB test was the third order of recommendation followed by the combined CCT and BTB (CCT+BTB) tests, where a positive result in either test denoted a positive response. The CCT test ranked last, as this test had the lowest sensitivity and would have allowed tuberculosis infection to remain in the zoo.
Enhancing the Care of the Elderly; An Educational Intervention to Improve Nutritional Knowledge of Nursing Home Staff
(1998-06-01) Cummings, Dana; Ramirez, Gilbert; Coggin, Claudia; Rene, Antonio
Cummings, Dana M., Enhancing the Care of Elderly; an Educational Intervention to Improve Nutritional Knowledge of Nursing Home Staff. Master of Public Health, June 1998, 81 p.p., 5 tables, bibliography, 15 titles. Gross deficiencies exist in the quality and quantity of health care personnel taking care of the aged (Hersch, 1989). Eighty to ninety percent of nursing home staff are untrained aides paid the minimum wage to care for one of the sickest and frailest populations in the United States (Patenaude, 1997). The purpose of this study was to determine if short term nutrition education, utilizing principles for adult learners, would result in knowledge improvement in nursing home staff. An interactive, participatory instructional model was implemented into an existing structure of regular staff inservices to answer this question. To test the effectiveness of the intervention a questionnaire was developed using items from previously validated instruments. Using three nursing homes in the Dallas-Fort Worth metroplex, a total of 157 pre-test and 132 post-test questionnaires were completed. A significant increase in overall knowledge from 80.6% at baseline to 96.1% at post-test was found (p [less than] .001). Participants also showed a significant (p [less than] 0.001) overall increase in knowledge for each of the three learning domains; patient care related to nutrition, food and fluid intake of residents, and eating. These findings suggest that employing short-term education to nursing home staff, using principles for adult learners, can improve nutritional knowledge significantly.
Breast Health 101: A Workshop Designed for the University Setting
(1998-06-06) Foster, Wednesday; Licciardone, John C.; Ramirez, Gilbert; Coggin, Claudia
Foster, Wednesday, Breast Health 101: A Workshop Designed for the University Setting. Master of Public Health, June 6, 1998, 81 pp., 18 tables, 1 figure, bibliography, 43 titles. A study of 18-25 year old female undergraduates was conducted to describe their level of breast health awareness, evaluate changes in awareness after a breast health workshop, and determine the effectiveness of the education. Variation in responses were evaluated using a pre/post-questionnaire design. Participants scored lower at baseline on knowledge and proficiency variables. The knowledge/proficiency score was significantly higher at post-questionnaire in both study groups. Lack of skill was identified as a barrier to breast self-examination, but fear, embarrassment, and forgetfulness were not. Lack of knowledge was not a barrier of BSE frequency. BSE skill and frequency were significantly higher in the intervention group post-intervention.
The Effects of Hyperlipidemia and Hypoglycemia on Myocardial Contractile Function and Oxygen Utilization During Coronary Hypoperfusion
(1998-08-01) Hart, Bradley Joe; Downey, H. Fred; Mallet, Robert T.; Smith, Michael B.
Hart, Bradley Joe, The Effects of Hyperlipidemia and Hypoglycemia on Myocardial Contractile Function and Oxygen Utilization During Coronary Hypoperfusion Master of Science (Biomedical Sciences), August, 1998, 85 pp., 1 table, 5 figures, references, 51 titles. This study was designed to determine the effects of elevated fatty acid and lowered glucose concentrations on myocardial contractile function and substrate selection during hypoperfusion. Coronary perfusion pressure (CPP) was lowered in the left anterior descending coronary artery of open-chest anesthetized dogs. Glucose uptake, fatty acid uptake, and percent segment shortening (%SS) were determined with normal arterial FFA concentrations (Group 1) or with elevated concentrations (Groups 2 and 3). When glucose was removed by dialysis in Group 3, FFA uptake increased and glucose uptake decreased relative to Group 1 at 40 mmHg CPP (p [less than] 0.05). Oxygen consumption significantly increased (p [less than] 0.05); however, %SS was unchanged. Thus, although the myocardium switches from fatty acid to glucose metabolism to increase oxygen utilization efficiency during hypoperfusion, blocking this switch does not contribute to a further decrease in myocardial contractile function.
Population Characteristics Suggest Modifications to Proposed Pediatric Asthma Intervention Program
(1998-08-01) DeMoss, Margaret W.; Ramirez, Gilbert; Urrutia-Rojas, Ximena; Coggin, Claudia
DeMoss, Margaret W., Population Characteristics Suggest Modifications to Proposed Pediatric Asthma Intervention Program. Master of Public Health, August, 1998, 57 pp., 4 tables, 1 illustration, 2 appendices, reference list, 46 titles. Asthma is the most common chronic childhood disease affecting almost 5 million children in this country. The children most as risk for developing asthma come from low income, minority, and urban families. This studies examines a proposed pediatric asthma intervention program targeting Tarrant County area Medicaid clients. The purpose of this study is to define different subgroups and preferences among those clients and to recommend modifications that are likely to improve program outcomes. Recommendations were based on information gathered from interviews with 70 families, all having at least one child with asthma. Specific interests in learning more about asthma as well as learning preferences are tested for association with a variety of family characteristics. Although no statistically significant results were determined for subgroups, descriptive findings reveal that a large minority of respondents are interested in more information about asthma, but not necessarily by the means proposed. The study also suggests special needs for families with very young children, for those with adult asthma, and for Hispanics.
Demographics of a University Based Geratric Medicine House Call Program
(1999-05-01) Dunn, Leslie K.
There has been a steady decline in the frequency of house calls by physicians during the 20th century. The reasons most commonly given for not making house calls are time constraints and poor reimbursements for the amount of time spent (1). Unlike younger age groups, those 65 and older tend to have physical limitations that prohibit routine visits to clinics (2). In a university based geriatric practice, there is a subgroup of individuals who are unable to access health care or see a physician without considerable expense and effort via ambulance transportation services. Without a physician house call visit, these older adults would not have routine access to health care (3). The Gerontology Assessment and Planning Program (GAP) at the University of North Texas Health Science Center at Fort Worth (UNTHSC) is involved in providing a physician directed house call program. By 2030, it is estimated that the older adults will comprise 25% of the total population (4). Encouraging independent living supported by community-based services will result in a greater number of homebound older adults requiring house calls by physicians (5). The challenge is to determine those likely to require house call services and the medical conditions and physical disabilities leading to the need for in home services. To understand the conditions and needs of these geriatric patients, a retrospective chart review was conducted. The study reviewed the demographic characteristics of the patients seen through the house call program, prevalent sources of referrals, health assessment at the point of admission into the house call program, profile of primary care givers and factors in the decision making process that physicians used to place patients on the service. Outcome data are presented including hospital admissions and deaths while on the house call program.
An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly
(1999-05-01) Johs, Jennifer L.
Johs, Jennifer L. An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly. Master of Public Health (Biomedical Sciences), May, 1999, 57 pp., 4 tables, references, 66 titles. The current study compared utilization markers of 87 frail elderly homebound patients prior to and subsequent to enrollment in an interdisciplinary, physician-led house calls program, as well as measured efforts to increase documentation of advance directives. After enrollment in the program the number of hospital admissions (p=0.047) and emergency department visits (p=0.030) were significantly decreased. The number of admissions to skilled nursing facilities (p=0.023) was also reduced, as was length of stay in skilled nursing facilities (p=0.018). The prevalence of advance directives increased from 26% to 74% (p [less than] 0.001) subsequent to enrollment. Patients who died were more likely to die at home (19) than in the hospital (6). All patients who died at home had documented advance directives.
Stress and Social Support as Risk Factors for the Occurrence of Neural Tube Defect-Affected Pregnancies in Women Living Along the Texas-Mexico Border
(1999-06-01) Herron, Kathryn M.; Rene, Antonio; Licciardone, John C.; Ramirez, Gilbert
Herron, Kathryn M., Stress and Social Support as Risk Factors for the Occurrence of Neural Tube Defect-Affected Pregnancies in Women Living Along the Texas-Mexico Border. Master of Public Health, June, 1999, 59 pp., 8 tables, 1 figure, references, 78 titles. Data were derived from the case-control study of the Texas Department of Health’s Neural Tube Defect Project, involving women living along the Texas-Mexico border, June 1995 to October 1998. Social support and stress information was obtained from a questionnaire, and a residual stress scale was created to determine an aggregate measure for each subject. Interviews were conducted with 261 women, with 1.2 controls to each case. Having high residual stress was found to be a significant risk factor for NTDs. Other significant risk factors included periconceptional injury, residential mobility, having no relatives to talk about private matters, and discontent with relationships.
Risk Factors Associated with Low Bone Mineral Density and Hip Fracture Among United States 20-90 Years of Age (NHANES III Study)
(1999-06-01) Nandi, Shubhra; Rene, Antonio; Licciardone, John C.; Fong, Nelson C.
Nandi, Shubhra. Risk Factors Associated with Low Bone Mineral Diversity and Hip Fracture Among United States Females 20-29 Years of Age. (NHANES III Study). Master of Public Health, June 1999, 45p.p. Osteoporosis has become a great public health problem because of the growing segment of the elderly population. The manifestation of osteoporosis results in morbidity with disability and a diminished quality of life due to hip fracture and spine fracture. This is also the major cause of hospital expenditure. Thus, understanding the development of low bone mineral density at various skeletal sites and the prevention of the causes related to the diminished bone mineral density is of great importance. This is a descriptive study of risk factors associated with low bone mineral density and hip fracture among United States females 20-90 years of age. Data was collected by the National Center for Health Statistics from 1988-1994 in two phases. Several risk factors have been associated with low bone mineral density. They are age, race, body mass index, fat-free mass, smoking, alcohol intake, caffeine intake, calcium supplement intake, dairy intake, and the level of physical activity. The primary objective of this study was to elucidate the relationship of low bone mineral density in a specific race-ethnic population with the perceived risk factors. This cross-sectional study provides information to confirm that Non-Hispanic Whites have low bone mineral density at the end of their decade of life compared to Non-Hispanic Blacks and Hispanic Americans. A significant association between low bone mineral density and age, race ethnicity, body mass index, and milk intake was detected (P [less than] 0.05). Other factors did not display any statistically significant correlation.
Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment
(1999-07-01) Perkins, Christopher J.; Rene, Antonio; Mains, Doug A.; Ramirez, Gilbert
Perkins, Christopher J., Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment. Master of Public Health (Biomedical Sciences), July, 1999, 60 pp., 8 tables, 4 illustrations, references, 31 titles. The challenge to government, medical and public health officials is to advocate for American citizens the safest environment possible to live and work. A threat to the safety of all Americans has initiated preparations from national, state, and local jurisdictions in an attempt to counter the probability of biological terrorism. Bioterrorism is not only a threat to humans but also a threat to the nation’s water and food supplies. Epidemiological Modeling of a Bioterrorism Event demonstrates the importance in preparations to reduce the number of casualties and fatalities. Using Epidemiological Modeling of bioterrorism events will aid public health and medical personnel in the planning and initiation of appropriate public health actions and medical therapies should such events occur.
A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas
(1999-08-01) Omoloh, Wilfred J.; Ramirez, Gilbert; Rene, Antonio
Omoloh, Wilfred, J., A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas. Master of Public Health, August 14, 1999, 110 pp, 19 tables, reference list, 68 titles. A descriptive study of adolescent pregnancy and birth outcomes in Tarrant county, Texas between 1991 and 1995 was conducted to evaluate the effect of maternal age on infant birthweight and mortality among White, African American, and Hispanic adolescent mothers nineteen years and older. The age of the mother was not a significant predictor of infant birthweight and mortality, but mother’s ethnicity, weight gain, and gestational age were found to be strong predictors of infant birthweight and mortality. The Hispanic ethnic group came out much better than White and Black mothers but no difference between White and Black mothers regarding birthweight was found. The results from the data analysis demonstrated that teenage pregnancy may not be a serious problem in Tarrant County, Texas as was previously though.
Quality Assurance Review of the Department of Radiology's Processes at the Osteopathic Medical Center of Texas
(1999-12-01) Mego, Charles B.W.; Coggin, Claudia; Mains, Doug A.
Mego, Charles B.W., Quality Assurance Review of the Department of Radiology’s Processes at the Osteopathic Medical Center of Texas. Master of Public Health, December 1999, 40 p.p., 4 illustrations, reference list. The Osteopathic Medical Center of Texas (OMCT), a 300 bed teaching hospital, must look at maximizing quality assurance measures in or order to become more economically viable. A 24 hour final report turnaround time has been set as the gold standard in radiology departments world wide, compared to turn around times typically three or four times greater than the gold standard in OMCT’s radiology department. A retrospective and prospective approach were conducted over a period of six months to review the radiology process components. The draft report to signed report activity area, where report transcriptions are revised and signed by the radiologists, takes up a majority of the process time with over 50% per patient case in both the retrospective and prospective approaches. The draft to signed area can be targeted for quality improvement, with possible implementation options such as voice recognition or retooling the five week rotation schedule.
Cardiorespiratory Fitness, Body Mass Index and All-Cause Mortality in Women, ACLS 1970-1994
(1999-12-01) Braun, LeeAnn; Blakley, Sally; Rene, Antonio A.
Braun, LeeAnn, Cardiorespiratory Fitness, Body Mass Index and All-Cause Mortality in Women, Aerobics Center Longitudinal Study, 1970-1994. Master of Public Health (Epidemiology), December, 1999, 44 p.p., 9 tables, references, 24 titles. Cardiorespiratory fitness and body mass index are related to morbidity and mortality (Manson, 1996). There is a preponderance of evidence supporting this relation in men (Gibbons, 1983; Blair, 1989, 1995, 1996; Lee, I, 1993; Barlow, 1995; Kampert, 1996; Dorn, 1997; Lee, C, 1999). The evaluation of the stated risk factors have been virtually unexplored in a cohort of women. The aim of this study is to evaluate whether higher levels of cardiorespiratory fitness attenuate the risk of all-cause mortality in overweight and obese women. In this prospective study, the study population consisted of 7572 women ages 20-89 years, who had a medical examination and achieved at least 85% of their age-adjusted maximal heart rate during a maximal treadmill test were followed for 69,979 woman-years. After adjustment for age, exam year, health status and smoking status, unfit women had a higher risk for all-cause mortality across BMI categories [RR 1.70 95% CI (1.18, 2.43)]. The benefits of cardiorespiratory fitness significantly decrease the risk of all-cause mortality in women as the concurrent consideration of cardiorespiratory fitness.
Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community - A Six Month Follow-Up
(1999-12-01) Coustasse, Alberto; Rene, Antonio; Mains, Doug A.; Ramirez, Gilbert
Coustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results demonstrated a 46% increase in BMI [Body Mass Index]; 62% remained obese; 62% maintained elevated cholesterol or increased cholesterol values to abnormal values; 61% maintained or increased their BP [blood pressure] to abnormal values. A significant finding was that a change of one unit in the BMI correlated with a change of 19.88 mmHg [millimeter mercury] of SBP [systolic blood pressure] and 18.59 mmHg of DBP [diastolic blood pressure]. The societal economic impact of mortality and morbidity (without the benefit of target interventions) for the initial forty-four seniors was projected at & 74,949. Keywords: Health fairs; obesity; cardiovascular; cost; case management.
Meta-analysis: Effects of Opuntia Species
(2000-05-01) Garcia, Anna R.; Licciardone, John C.; Ramirez, Gilbert; Fong, Nelson C.
Garcia, Anna R., Meta-analysis: Effects of Opuntia species. Master of Public Health (Epidemiology), May, 2000, 73 pp., 10 tables, 10 figures, references, 62 titles. The Mexican American population is more susceptible to diabetes mellitus due to a number of risk factors. The earliest recorded treatments for diabetes mellitus involved the use of natural plants. Opuntia species are any member of the genus Opuntia of Cactus family and who are native to the Western Hemisphere. In order to determine the efficacy of Opuntia species as a hypoglycemic agent in non-insulin dependent diabetics, a meta-analysis was conducted to analyze the identified studies. In addition, insulin and the presence of a dose-response relationship upon ingestion of Opuntia were investigated. A statistically significant reduction in serum glucose was found after the ingestion of 500 grams of Opuntia species. Additional studies are needed to determine the mechanism of hypoglycemic action and to further investigate the properties of Opuntia species.
Gender Differences: Making the Decision to Seek Treatment for Symptoms of Acute Myocardial Infarction
(2000-05-01) Borski, Catherine A.; Reed, Shelia; Doster, Joseph; Coggin, Claudia
Borski, Catherine A., Gender Differences: Making the decision to seek treatment for symptoms of acute myocardial infarction. Masters of Public Health (Health Behavior), May, 2000, 57 pp., reference list, 37 titles. The purpose of this study was to investigate the problem: Do differences in interpretation and response to symptoms of AMI account for additional delay in seeking treatment in women compared with men? The sample consisted of 50 (21 women, 29 men) post-myocardial infarction patients in a large, non-profit, teaching hospital in central Texas. Participants were interviewed within 72 hours of admission using the Revised Response to Symptoms questionnaire. In this study, it was found that there was a statistically significant difference between the cognitive and emotional processes that men and women use when making the decision to seek treatment for symptoms of AMI.
A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas
(2000-05-01) Williams, Vanessa P.; Rene, Antonio A.; Fairchild, Thomas J.; Blakley, Sally
Williams, Vanessa P., A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas. Master of Public Health (Epidemiology), May 2000, 55 pp., 11 tables, 9 figures, references, 52 titles. The cancer experience of Texans differs substantially by race/ethnicity. Among Caucasian, African American, and Hispanic men and women, colon cancer is either the second or third leading type of cancers among Texans. The distribution of time to death over a six-year period were assessed from a cohort of African American, Hispanic, and Caucasian men and women diagnosed with colon cancer in 1992. The purpose of this study is to determine if there is a difference in the overall death time distribution and tumor histology among African Americans, Hispanics, and Caucasian men and women who were diagnosed with colon cancer in 1992 in the state of Texas. Analysis results indicated that Hispanic females (65.59%) and Caucasian males (65.52%) had higher survival times among the race/ethnic groups. African American males (53.85%) and females (56.40%) experienced lower survival time for the cohort. For overall distribution of time to death among deceased subjects, African American males and Hispanic females experienced the lowest distribution times among the subjects. The overall distribution of time to death for all histology types were the same for each type.
Prevalence of Hand, Finger, and Wrist Musculoskeletal Problems in Keyboard Instrumentalists: The University of North Text Musician Health Survey
(2000-05-01) Pak, Chong H.; Blakley, Sally; Rene, Antonio; Licciardone, John C.
Pak, Chong H., Prevalence of Hand, Finger, and Wrist Musculoskeletal Problems in Keyboard Instrumentalists: the University of North Texas Musician Health Survey. Master of Public Health, May, 2000, 52 pp., 7 tables, references, 69 titles. Data were derived from the University of North Texas Musician Health Survey, involving keyboard instrumentalists. 455 keyboard instrumentalists were selected and musician type, daily playing time, gender, and age were examined as possible risk factors for musculoskeletal problems of the hand, finger, and wrist. Age was found to be a significant risk factor when all levels of pain were considered. Gender was found to be a significant risk factor for all levels of pain as well as severe pain. Musician type and daily playing time did not show statistical differences.

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